Individual
SHAILLY SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
52 THOMAS JOHNSON DR, FREDERICK, MD 21702-4501
(301) 631-0501
Mailing address
11300 LANDY LN, GREAT FALLS, VA 22066-1569
(703) 626-0581
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
18138
MD
390200000X
Student in an Organized Health Care Education/Training Program
13417
CT
Other
Enumeration date
04/17/2022
Last updated
07/05/2024
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